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Fischbach W, Bornschein J, Hoffmann JC, Koletzko S, Link A, Macke L, Malfertheiner P, Schütte K, Selgrad DM, Suerbaum S, Schulz C. Update S2k-Guideline Helicobacter pylori and gastroduodenal ulcer disease of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:261-321. [PMID: 38364851 DOI: 10.1055/a-2181-2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Affiliation(s)
| | - Jan Bornschein
- Translational Gastroenterology Unit John, John Radcliffe Hospital Oxford University Hospitals, Oxford, United Kingdom
| | - Jörg C Hoffmann
- Medizinische Klinik I, St. Marien- und St. Annastiftskrankenhaus, Ludwigshafen, Deutschland
| | - Sibylle Koletzko
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU-Klinikum Munich, Munich, Deutschland
- Department of Paediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Alexander Link
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - Lukas Macke
- Medizinische Klinik und Poliklinik II Campus Großhadern, Universitätsklinikum Munich, Munich, Deutschland
- Deutsches Zentrum für Infektionsforschung, Standort Munich, Munich, Deutschland
| | - Peter Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
- Medizinische Klinik und Poliklinik II Campus Großhadern, Universitätsklinikum Munich, Munich, Deutschland
| | - Kerstin Schütte
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Niels-Stensen-Kliniken Marienhospital Osnabrück, Osnabrück, Deutschland
| | - Dieter-Michael Selgrad
- Medizinische Klinik Gastroenterologie und Onkologie, Klinikum Fürstenfeldbruck, Fürstenfeldbruck, Deutschland
- Klinik für Innere Medizin 1, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Sebastian Suerbaum
- Universität Munich, Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Munich, Deutschland
- Nationales Referenzzentrum Helicobacter pylori, Pettenkoferstr. 9a, 80336 Munich, Deutschland
- Deutsches Zentrum für Infektionsforschung, Standort Munich, Munich, Deutschland
| | - Christian Schulz
- Medizinische Klinik und Poliklinik II Campus Großhadern, Universitätsklinikum Munich, Munich, Deutschland
- Deutsches Zentrum für Infektionsforschung, Standort Munich, Munich, Deutschland
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2
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Lei X, Cui ZY, Huang XJ. Exploration of gastric carcinogenesis from the relationship between bile acids and intestinal metaplasia and intragastric microorganisms (H. pylori and non-H. pylori). J Cancer Res Clin Oncol 2023; 149:16947-16956. [PMID: 37707577 DOI: 10.1007/s00432-023-05407-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
Gastric cancer (GC) is a prevalent form of cancer, with Helicobacter pylori (H. pylori) infection being the most common risk factor. Recent studies have highlighted the role of long-term irritation of the gastric mucosa caused by bile reflux in the development of cancer. Bile acids (BAs), which are a significant component in bile reflux, have the potential to promote gastric carcinogenesis through various mechanisms. These mechanisms include the induction of intestinal metaplasia (IM), inhibition of H. pylori activity, modification of H. pylori colonization, and alteration of the abundance and composition of microorganisms in the stomach. Defining the mechanism of bile acid-induced gastric carcinogenesis could potentially be an effective approach to prevent GC. Hence, this paper aims to review the mechanism of bile acid-induced IM, the association between BAs and H. pylori infection as well as microorganisms in the stomach, and the correlation between BAs and gastric carcinogenesis. The ultimate goal is to elucidate the role of BAs in the development of GC.
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Affiliation(s)
- X Lei
- Department of Gastroenterology, The Lanzhou University Second Hospital, No. 82 of Linxia Street, Chengguan District, Lanzhou, 730030, China
| | - Z Y Cui
- Department of Gastroenterology, The Lanzhou University Second Hospital, No. 82 of Linxia Street, Chengguan District, Lanzhou, 730030, China
| | - X J Huang
- Department of Gastroenterology, The Lanzhou University Second Hospital, No. 82 of Linxia Street, Chengguan District, Lanzhou, 730030, China.
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3
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Aktualisierte S2k-Leitlinie Helicobacter
pylori und gastroduodenale Ulkuskrankheit der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – Juli 2022 – AWMF-Registernummer: 021–001. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:544-606. [PMID: 37146633 DOI: 10.1055/a-1975-0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
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4
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Romano M, Gravina AG, Eusebi LH, Pellegrino R, Palladino G, Frazzoni L, Dajti E, Gasbarrini A, Di Mario F, Zagari RM. Management of Helicobacter pylori infection: Guidelines of the Italian Society of Gastroenterology (SIGE) and the Italian Society of Digestive Endoscopy (SIED). Dig Liver Dis 2022; 54:1153-1161. [PMID: 35831212 DOI: 10.1016/j.dld.2022.06.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 12/18/2022]
Abstract
Helicobacter pylori infection is very common and affects more than one-third of adults in Italy. Helicobacter pylori causes several gastro-duodenal diseases, such as gastritis, peptic ulcer and gastric malignancy, and extra-gastric diseases. The eradication of the bacteria is becoming complex to achieve due to increasing antimicrobial resistance. To address clinical questions related to the diagnosis and treatment of Helicobacter pylori infection, three working groups examined the following topics: (1) non-invasive and invasive diagnostic tests, (2) first-line treatment, and (3) rescue therapies for Helicobacter pylori infection. Recommendations are based on the best available evidence to help physicians manage Helicobacter pylori infection in Italy, and have been endorsed by the Italian Society of Gastroenterology and the Italian Society of Digestive Endoscopy.
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Affiliation(s)
- Marco Romano
- Department of Precision Medicine and Complex Operative Unit of Hepatogastroenterology and Digestive Endoscopy, University Hospital, University of Campania "Luigi Vanvitelli", Via Luigi de Crecchio, 80138, Napoli, Italy.
| | - Antonietta Gerarda Gravina
- Department of Precision Medicine and Complex Operative Unit of Hepatogastroenterology and Digestive Endoscopy, University Hospital, University of Campania "Luigi Vanvitelli", Via Luigi de Crecchio, 80138, Napoli, Italy
| | - Leonardo Henry Eusebi
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Raffaele Pellegrino
- Department of Precision Medicine and Complex Operative Unit of Hepatogastroenterology and Digestive Endoscopy, University Hospital, University of Campania "Luigi Vanvitelli", Via Luigi de Crecchio, 80138, Napoli, Italy
| | - Giovanna Palladino
- Department of Precision Medicine and Complex Operative Unit of Hepatogastroenterology and Digestive Endoscopy, University Hospital, University of Campania "Luigi Vanvitelli", Via Luigi de Crecchio, 80138, Napoli, Italy
| | - Leonardo Frazzoni
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Elton Dajti
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Antonio Gasbarrini
- Complex Operating Unit of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Via della Pineta Sacchetti, 217, 00168, Rome, Italy
| | - Francesco Di Mario
- Geriatric-Rehabilitation Department, University of Parma, Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, 43126, Parma, Italy
| | - Rocco Maurizio Zagari
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
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5
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Wada Y, Mukaisho KI, Kanai S, Nakayama T, Fukuda M, Mizukami K, Okimoto T, Kodama M, Sugihara H, Murakami K, Kushima R. Development of Pancreatic Acinar Cell Metaplasia During Gastric Repair in a Rat Duodenal Contents Reflux Model. Dig Dis Sci 2021; 66:1072-1079. [PMID: 32440745 PMCID: PMC7990820 DOI: 10.1007/s10620-020-06342-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND We previously reported the development of pancreatic acinar cell metaplasia (PACM) in the glandular stomach of a duodenal contents reflux model (reflux model). AIMS We aimed to investigate the characteristics and histogenesis of PACM using a reflux model. METHODS A reflux model was created using 8-week-old male Wistar rats, which were killed up to 30 weeks postoperatively. Histological examination was performed to analyze the glandular stomach-jejunal anastomosis. Furthermore, electron microscopic images of PACM samples were compared with pancreatic and gastric glands removed from rats that had not undergone surgery. Immunostaining for α-amylase, HIK1083, TFF2, and Ki-67 was performed, and double fluorescent staining was carried out using antibodies against α-amylase and HIK1083, or α-amylase and TFF2. RESULTS In all reflux model rats, PACM was observed proximal to the glandular stomach-jejunal anastomosis, surrounded by pseudopyloric metaplasia. The number of chief cells was decreased in the deep part of the gland, where PACM occurred. Electron microscopy showed that PACM cells had greater numbers of rough endoplasmic reticulum tubules than chief cells, and exhibited pancreatic acinar cell morphology. Upon immunochemical staining, the regenerative foveolar epithelium and part of the pseudopyloric glands stained strongly positive for TFF2, whereas PACM cells were only weakly positive. Double fluorescent staining identified early lesions of PACM in the neck, which were double positive for α-amylase and TFF2, but negative for HIK1083. CONCLUSIONS PACM could be induced by duodenal contents reflux. PACM originates from stem cells located in the neck of oxyntic glands during gastric mucosal regeneration.
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Affiliation(s)
- Yasuhiro Wada
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
- Department of Pathology, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
- Division of Diagnostic Pathology, Shiga University of Medical Science Hospital, Otsu, Japan
| | - Ken-Ichi Mukaisho
- Department of Pathology, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Shunpei Kanai
- Department of Pathology, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Takahisa Nakayama
- Department of Pathology, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masahide Fukuda
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Kazuhiro Mizukami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Tadayoshi Okimoto
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Masaaki Kodama
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Hiroyuki Sugihara
- Department of Pathology, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Ryoji Kushima
- Division of Diagnostic Pathology, Shiga University of Medical Science Hospital, Otsu, Japan
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6
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Kirilenko BM, Hagey LR, Barnes S, Falany CN, Hiller M. Evolutionary Analysis of Bile Acid-Conjugating Enzymes Reveals a Complex Duplication and Reciprocal Loss History. Genome Biol Evol 2019; 11:3256-3268. [PMID: 31670760 PMCID: PMC6934887 DOI: 10.1093/gbe/evz238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 12/01/2022] Open
Abstract
To fulfill their physiological functions, bile acids are conjugated with amino acids. In humans, conjugation is catalyzed by bile acid coenzyme A: amino acid N-acyltransferase (BAAT), an enzyme with a highly conserved catalytic triad in its active site. Interestingly, the conjugated amino acids are highly variable among mammals, with some species conjugating bile acids with both glycine and taurine, whereas others conjugate only taurine. The genetic origin of these bile acid conjugation differences is unknown. Here, we tested whether mutations in BAAT’s catalytic triad could explain bile acid conjugation differences. Our comparative analysis of 118 mammals first revealed that the ancestor of placental mammals and marsupials possessed two genes, BAAT and BAATP1, that arose by a tandem duplication. This duplication was followed by numerous gene losses, including BAATP1 in humans. Losses of either BAAT or BAATP1 largely happened in a reciprocal fashion, suggesting that a single conjugating enzyme is generally sufficient for mammals. In intact BAAT and BAATP1 genes, we observed multiple changes in the catalytic triad between Cys and Ser residues. Surprisingly, although mutagenesis experiments with the human enzyme have shown that replacing Cys for Ser greatly diminishes the glycine-conjugating ability, across mammals we found that this residue provides little power in predicting the experimentally measured amino acids that are conjugated with bile acids. This suggests that the mechanism of BAAT’s enzymatic function is incompletely understood, despite relying on a classic catalytic triad. More generally, our evolutionary analysis indicates that results of mutagenesis experiments may not easily be extrapolatable to other species.
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Affiliation(s)
- Bogdan M Kirilenko
- Max Planck Institute of Molecular Cell Biology and Genetics, Dresden, Germany.,Max Planck Institute for the Physics of Complex Systems, Dresden, Germany.,Center for Systems Biology, Dresden, Germany
| | - Lee R Hagey
- Department of Medicine, University of California at San Diego, USA
| | - Stephen Barnes
- Department of Pharmacology and Toxicology, Targeted Metabolomics and Proteomics Laboratory, University of Alabama, Birmingham, USA
| | - Charles N Falany
- Department of Pharmacology and Toxicology, Targeted Metabolomics and Proteomics Laboratory, University of Alabama, Birmingham, USA
| | - Michael Hiller
- Max Planck Institute of Molecular Cell Biology and Genetics, Dresden, Germany.,Max Planck Institute for the Physics of Complex Systems, Dresden, Germany.,Center for Systems Biology, Dresden, Germany
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7
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Sevencan NO, Cesur O, Cakar M, Dogan E, Ozkan AE, Benli AR. Mean platelet volume and red cell distribution width as potential new biomarkers in children with gastroesophageal reflux disease. Am J Transl Res 2019; 11:3176-3186. [PMID: 31217887 PMCID: PMC6556640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
The aim of this study was to calculate the corrected rate of reflux in children with gastroesophageal reflux (GER)-like complaints by 24-hour pH monitoring and esophagogastroduodenoscopy (EGD), and to determine the utility of mean platelet volume (MPV) and red cell distribution width (RDW) as diagnostic biomarkers of GER disease (GERD) in children. The subjects in this prospective study were 109 children, 6 to 18 years old. Of them, 74 subjects were with GER symptoms and 35 healthy controls. The subjects were divided into three groups: those who underwent 24-hour pH monitoring (Group 1), those who underwent EGD together with pH monitoring (Group 2), and the healthy controls (Group 3). The results of pH monitoring and EGD and hematological parameters with controls were compared between Groups 1 and 2. In Groups 1 and 2, the overall rate of reflux was 40%, of esophagitis was 27.8%, and of Helicobacter pylori infection was 31.2%. The MPV and RDW cut-offs in subjects with reflux were ≤ 8.97 (sensitivity 89%, specificity 89%) and ≤ 12.78 (sensitivity 80%, specificity 97%), with an area under the Receiver Operating Characteristic (ROC) curve ± standard error (AUC ± SE) = 0.917 ± 0.027 (P < 0.001) and AUC ± SE = 0.866 ± 0.036 (P < 0.001), respectively. The endoscopic procedures are not practical due to being invasive and expensive. However, hemogram is a simple test which can be performed in an outpatient clinic. MPV and RDW calculated in hemogram could be easy, cost-effective, and high sensitive new biomarkers that can be used in children with GERD.
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Affiliation(s)
| | - Ozkan Cesur
- Department of Pediatric Surgery, The University of Karabuk, Medical FacultyTurkey
| | - Murat Cakar
- Department of Pediatric Surgery, The University of Karabuk, Medical FacultyTurkey
| | - Erkan Dogan
- Department of Pediatrics, The University of Karabuk, Medical FacultyTurkey
| | | | - Ali Ramazan Benli
- Department of Family Physician, The University of Karabuk, Medical FacultyTurkey
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8
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Zhao YN, Xu CP. Etiology, pathogenesis, diagnosis and treatment of bile reflux gastritis. Shijie Huaren Xiaohua Zazhi 2018; 26:1886-1892. [DOI: 10.11569/wcjd.v26.i32.1886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Bile reflux gastritis is a common disease of the digestive system, whose clinical characteristics are abdominal pain, abdominal distention and nausea and vomiting, affecting the quality of life of patients seriously. However, the etiology and pathogenesis of bile reflux gastritis are still unclear, which may be related to gastrointestinal surgery, gallbladder disease, Helicobacter pylori infection, psychological factors, etc. There are many diagnostic methods, but a consensus on diagnosis is still lacking. Most of the current treatments are symptomatic treatments, but the overall efficacy is poor. This article reviews the etiology, pathogenesis, diagnosis and treatment of bile reflux gastritis, with an aim to provide a reference for further research of this disease.
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Affiliation(s)
- Ya-Nan Zhao
- Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Cui-Ping Xu
- Department of Gastroenterology, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
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9
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Lupu VV, Ignat A, Ciubotariu G, Ciubară A, Moscalu M, Burlea M. Helicobacter pylori infection and gastroesophageal reflux in children. Dis Esophagus 2016; 29:1007-1012. [PMID: 26455913 DOI: 10.1111/dote.12429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Some studies suggest that Helicobacter pylori (H. pylori) infection would be a protective factor for the gastroesophageal reflux. The aim of this study was to explore this fact. A group of 72 children, admitted in a pediatric gastroenterology regional center in Northeast Romania, diagnosed with gastroesophageal reflux by 24-hour continuous esophageal pH monitoring (results were interpreted using the Boix-Ochoa score), underwent upper endoscopy with gastric biopsy to detect the presence of H. pylori by the rapid urease testing and for bacteriological and histologic examination. 19 children (26.39%) had H. pylori infection, while 53 (73.61%) did not. The grade of esophagitis was classified according to the Los Angeles classification system. Out of 47 children with esophagitis A, 16 (34.04%) had H. pylori infection, while out of the 25 children with esophagitis B, only 3 (12%) had H. pylori infection, with statistic significance (χ2 = 54.69, P << 0.05, 95% confidence interval [CI]). Regarding the value of the Boix-Ochoa score, it appears that the presence of the H. pylori determines lower pH-metry scores (F = 8.13, P = 0.0015, 95% CI). The presence of the H. pylori was not an important factor in the gastroesophageal reflux. On the other hand its relationship with esophagitis appears to be inverse ratio. The fact that the H. pylori presence is statistically greater in the grade A esophagitis could confirm the hypothesis that the bacteria would slow down the development of the esophagitis.
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Affiliation(s)
- V V Lupu
- Pediatrics Department, University of Medicine and Pharmacy 'Gr. T. Popa', Iasi, Romania
| | - A Ignat
- Pediatrics Department, University of Medicine and Pharmacy 'Gr. T. Popa', Iasi, Romania
| | - G Ciubotariu
- Pediatrics Department, University of Medicine and Pharmacy 'Gr. T. Popa', Iasi, Romania
| | - A Ciubară
- Psychiatry Department, University of Medicine and Pharmacy 'Gr. T. Popa', Iasi, Romania
| | - M Moscalu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy 'Gr. T. Popa', Iasi, Romania
| | - M Burlea
- Pediatrics Department, University of Medicine and Pharmacy 'Gr. T. Popa', Iasi, Romania
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Nobakht H, Boghratian A, Sohrabi M, Panahian M, Rakhshani N, Nikkhah M, Ajdarkosh H, Hemmasi G, Khonsari M, Gholami A, Rabiei N, Zamani F. Association between Pattern of Gastritis and Gastroesophageal Reflux Disease in Patients with Helicobacter Pylori Infection. Middle East J Dig Dis 2016; 8:206-211. [PMID: 27698970 PMCID: PMC5045673 DOI: 10.15171/mejdd.2016.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND
Reflux disease is a common gastrointestinal problem. The association between reflux disease and gastritis pattern is controversial.
AIM: To determine the association between reflux disease and gastritis pattern in patients with Helicobacter pylori (H. pylori) infection.
METHODS
470 patients with dyspepsia and reflux disease were enrolled in this study. The inclusion criteria were willing to participate in the study, age over 40 years, and having the criteria of ROME III for at least 3 months. Patients with history of H. pylori eradication therapy during the 3 months before the study, a history of gastric surgery, and gastric cancer were excluded. All of the participants underwent upper endoscopy and two biopsy samples were taken from antrum, body, and fundal areas.
RESULTS H. pylori infection rate was 367 (78.1%) with mean age of 59.8 ± 11.4 years. Of them 131 patients (35.7%) were male. Reflux disease was detected in 273 (74.4%) patients. 216 (58.9%) and 102 (27.8%) patients had non-erosive reflux disease (NERD) and gastroesophageal reflux disease (GERD), respectively. Corpus predominant and antral predominant gastritis were seen in 72 (19.6%) and 129 (35.2%) patients, respectively. Antral gastritis was significantly associated with GERD (p<0.01). In regression analysis, antral predominant gastritis had a significant association with GERD (OR=1.92; 95%CI: 1.22- 3.12). The same result was observed in mild to moderate antral and greater curvature gastritis (OR= 1.26; 95%CI: 0.25-6.40 and OR= 3.0; 95%CI: 0.63-14.17, respectively).
CONCLUSION
According to these finding ,we could suggest that the pattern of gastritis could be associated with reflux disease and GERD.
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Affiliation(s)
- Hossein Nobakht
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran ; Department of Internal Medicine , Semnan University of Medical Sciences , Semnan ,Iran
| | - Amirhossein Boghratian
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran ; Department of Gastroenterology, RasolAkram Hospital, Iran University of Medical Sciences.Tehran,Iran
| | - Masoudreza Sohrabi
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Panahian
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Naser Rakhshani
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Nikkhah
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ajdarkosh
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Hemmasi
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoodreza Khonsari
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Gholami
- Department of Public Health, School of Health, Neyshabour University of Medical Sciences, Neyshabur, Iran ; Department of Epidemiology, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Rabiei
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Zamani
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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11
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Laczkó D, Rosztóczy A, Birkás K, Katona M, Rakonczay Z, Tiszlavicz L, Róka R, Wittmann T, Hegyi P, Venglovecz V. Role of ion transporters in the bile acid-induced esophageal injury. Am J Physiol Gastrointest Liver Physiol 2016; 311:G16-31. [PMID: 27198194 DOI: 10.1152/ajpgi.00159.2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 04/20/2016] [Indexed: 01/31/2023]
Abstract
Barrett's esophagus (BE) is considered to be the most severe complication of gastro-esophageal reflux disease (GERD), in which the prolonged, repetitive episodes of combined acidic and biliary reflux result in the replacement of the squamous esophageal lining by columnar epithelium. Therefore, the acid-extruding mechanisms of esophageal epithelial cells (EECs) may play an important role in the defense. Our aim was to identify the presence of acid/base transporters on EECs and to investigate the effect of bile acids on their expressions and functions. Human EEC lines (CP-A and CP-D) were acutely exposed to bile acid cocktail (BAC) and the changes in intracellular pH (pHi) and Ca(2+) concentration ([Ca(2+)]i) were measured by microfluorometry. mRNA and protein expression of ion transporters was investigated by RT-PCR, Western blot, and immunohistochemistry. We have identified the presence of a Na(+)/H(+) exchanger (NHE), Na(+)/HCO3 (-) cotransporter (NBC), and a Cl(-)-dependent HCO3 (-) secretory mechanism in CP-A and CP-D cells. Acute administration of BAC stimulated HCO3 (-) secretion in both cell lines and the NHE activity in CP-D cells by an inositol triphosphate-dependent calcium release. Chronic administration of BAC to EECs increased the expression of ion transporters compared with nontreated cells. A similar expression pattern was observed in biopsy samples from BE compared with normal epithelium. We have shown that acute administration of bile acids differently alters ion transport mechanisms of EECs, whereas chronic exposure to bile acids increases the expression of acid/base transporters. We speculate that these adaptive processes of EECs represent an important mucosal defense against the bile acid-induced epithelial injury.
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Affiliation(s)
- Dorottya Laczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary; First Department of Medicine, University of Szeged, Szeged, Hungary
| | - András Rosztóczy
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Birkás
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Máté Katona
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Zoltán Rakonczay
- First Department of Medicine, University of Szeged, Szeged, Hungary; Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | | | - Richárd Róka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tibor Wittmann
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- First Department of Medicine, University of Szeged, Szeged, Hungary; MTA-SZTE Translational Gastroenterology Research Group, University of Szeged, Szeged, Hungary; and Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Viktória Venglovecz
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary;
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Hagiwara T, Mukaisho KI, Nakayama T, Hattori T, Sugihara H. Proton pump inhibitors and helicobacter pylori-associated pathogenesis. Asian Pac J Cancer Prev 2015; 16:1315-9. [PMID: 25743791 DOI: 10.7314/apjcp.2015.16.4.1315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The fact that long-term use of proton pump inhibitors (PPIs) aggravates corpus atrophic gastritis in patients with Helicobacter pylori infection has been proven clinically and experimentally. Corpus atrophic gastritis is a known risk factor for gastric cancer. Therefore, gastric neoplasia might be associated with the long-term use of PPIs. One of the causes of worsening corpus atrophic gastritis, leading to the development of adenocarcinoma, might be bacterial overgrowth under conditions of hypochlorhydria. The production of potentially carcinogenic N-nitrosocompounds by nitrosating organisms under conditions of hypochlorhydria might be associated with carcinogenesis. Interactions between bile acids, pH, and H. pylori might also contribute to carcinogenicity, especially in patients with gastro-esophageal reflux disease (GERD). The concentration of soluble bile acids, which have bactericidal or chemorepellent properties toward H. pylori, in gastric contents is considerably higher in patients undergoing continuous PPI therapy than in healthy individuals with normal acid production. Under these circumstances, H. pylori might colonize the stomach body rather than the pyloric antrum. Hypergastrinemia induced by PPI administration might promote the development of gastric cancer. Because the main cause of corpus atrophic gastritis is H. pylori infection, and not PPI administration, H. pylori infection should be eradicated before starting long-term PPI therapy.
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Affiliation(s)
- Tadashi Hagiwara
- Department of Pathology, Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Shiga, Japan E-mail :
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Abstract
PURPOSE OF REVIEW This review summarizes the past year's literature regarding the neuroendocrine and intracellular regulation of gastric acid secretion, discussing both basic and clinical aspects. RECENT FINDINGS Gastric acid facilitates the digestion of protein as well as the absorption of iron, calcium, vitamin B12, and certain medications. High acidity kills ingested microorganisms and limits bacterial overgrowth, enteric infection, and possibly spontaneous bacterial peritonitis. The main stimulants of acid secretion are gastrin, released from antral gastrin cells; histamine, released from oxyntic enterochromaffin-like cells; and acetylcholine, released from antral and oxyntic intramural neurons. Ghrelin and coffee also stimulate acid secretion whereas somatostatin, cholecystokinin, glucagon-like peptide-1, and atrial natriuretic peptide inhibit acid secretion. Although 95% of parietal cells are contained within the oxyntic mucosa (fundus and body), 50% of human antral glands contain parietal cells. Proton pump inhibitors are considered well tolerated drugs, but concerns have been raised regarding dysbiosis, atrophic gastritis, hypergastrinemia, hypomagnesemia, and enteritis/colitis. SUMMARY Our understanding of the functional anatomy and physiology of gastric secretion continues to advance. Such knowledge is crucial for improved management of acid-peptic disorders, prevention and management of neoplasia, and the development of novel medications.
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Mukaisho KI, Nakayama T, Hagiwara T, Hattori T, Sugihara H. Two distinct etiologies of gastric cardia adenocarcinoma: interactions among pH, Helicobacter pylori, and bile acids. Front Microbiol 2015; 6:412. [PMID: 26029176 PMCID: PMC4426758 DOI: 10.3389/fmicb.2015.00412] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/20/2015] [Indexed: 12/12/2022] Open
Abstract
Gastric cancer can be classified as cardia and non-cardia subtypes according to the anatomic site. Although the gastric cancer incidence has decreased steadily in several countries over the past 50 years, the incidence of cardia cancers and esophageal adenocarcinoma (EAC) continue to increase. The etiological factors involved in the development of both cardia cancers and EACs are associated with high animal fat intake, which causes severe obesity. Central obesity plays roles in cardiac-type mucosa lengthening and partial hiatus hernia development. There are two distinct etiologies of cardia cancer subtypes: one associated with gastroesophageal reflux (GER), which predominantly occurs in patients without Helicobacter pylori (H. pylori) infection and resembles EAC, and the other associated with H. pylori atrophic gastritis, which resembles non-cardia cancer. The former can be developed in the environment of high volume duodenal content reflux, including bile acids and a higher acid production in H. pylori-negative patients. N-nitroso compounds, which are generated from the refluxate that includes a large volume of bile acids and are stabilized in the stomach (which has high levels of gastric acid), play a pivotal role in this carcinogenesis. The latter can be associated with the changing colonization of H. pylori from the distal to the proximal stomach with atrophic gastritis because a high concentration of soluble bile acids in an environment of low acid production is likely to act as a bactericide or chemorepellent for H. pylori in the distal stomach. The manuscript introduces new insights in causative factors of adenocarcinoma of the cardia about the role of bile acids in gastro-esophageal refluxate based upon robust evidences supporting interactions among pH, H. pylori, and bile acids.
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Affiliation(s)
- Ken-ichi Mukaisho
- Division of Molecular Diagnostic Pathology, Department of Pathology, Shiga University of Medical Science, Otsu, Shiga, Japan
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